New Scope of Work, New Regions, Temporary Review Pause
You know that old saying, time flies by when you are having fun? Well, the older I get, it is more apt to say that time flies by regardless of the fun factor. I will leave it up to you, the reader, to decide if the 2014 QIO Program Transition was fun. Fun or not, here we are five years later and the 11th Scope of Work (SOW) is coming to an end.
On April 30th KEPRO and LIVANTA were again awarded the Beneficiary and Family Centered Care (BFCC-QIO) contracts for the 12th SOW that will run from 2019-2023. This article highlights fun activities related to this transition for you the provider and provides information about a temporary pause of Short Stay and Higher Weighted DRG (HWDRG) Reviews.
BFCC-QIO 12th Scope of Work, What You Need to Know and Do
Know Your Region
With the 11th SOW, KEPRO and LIVANTA provided services in 5 distinct Regions with each Region having a specific phone number and contact information. CMS has restructured the coverage areas for the 12th SOW based on the Medicare Regional Offices. Effective June 8, 2019 there will be ten Regions as outlined in the following table:
|BFCC-QIO 12th Scope of Work Regions|
|Region||States in Region||BFCC-QIO|
|1||Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont||KEPRO|
|2||New York, New Jersey, Puerto Rico, Virgin Islands||LIVANTA|
|3||Pennsylvania, Maryland, Delaware, DC, Virginia, West Virginia||LIVANTA|
|4||Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee||KEPRO|
|5||Ohio, Indiana, Illinois, Michigan, Minnesota, Wisconsin||LIVANTA|
|6||Arkansas, Louisiana, New Mexico, Oklahoma, Texas||KEPRO|
|7||Iowa, Missouri, Kansas, Nebraska||LIVANTA|
|8||Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming||KEPRO|
|9||California, Arizona, Nevada, Hawaii, Guam, Northern Mariana Islands, American Samoa||LIVANTA|
|10||Alaska, Idaho, Oregon, Washington||KEPRO|
Update Your Appeals Notices
Acute care providers will need to update the Important Message from Medicare (IM) with the correct BFCC-QIO name and phone number for your region. Both LIVANTA and KEPRO have indicated that it is acceptable to use labels to cover the existing information on your current appeals notices.
Memorandum of Agreement
A new Memorandum of Agreement (MOA) is required for ALL Medicare health care providers (even if your BFCC-QIO is not changing). KEPRO has a page dedicated to MOA updates, and includes FAQs and a link to sign up for an email distribution list to receive updates from KEPRO.
Phone Numbers for BFCC QIO Services
Again, effective June 8th, all calls should be directed to phone numbers provided on the BFCC-QIO websites. As this time, KEPRO and LIVANTA will continue to handle all discharge appeals, quality complaints and immediate advocacy for Medicare patients and families.
All transition updates, including phone numbers, are available on KEPRO and LIVANTA’s websites at:
- KEPRO Transition webpage: https://www.keproqio.com/providers/transition
- LIVANTA Transition webpage: https://livantaqio.com/en/provider/transition.
Temporary Pause of BFCC-QIO Short Stay and Higher Weighted DRG Reviews
In the 11th SOW the BFCC-QIOs were responsible for HWDRG and Short Stay Reviews. As of May 8, 2019, a temporary pause was placed on both types of reviews. Per CMS, this action was taken to procure a new BFCC-QIO contractor and going forward HWDRG and Short Stay reviews will resume with a single organization performing these reviews on a national basis.
CMS anticipates a contract award to be issued by the 3rd quarter of calendar year 2019. MMP will continue to follow this story and report as soon as a contract is awarded. In the meantime, have fun identifying your BFCC-QIO, updating your Appeals Notices, and completing a new MOA.
Article by Beth Cobb
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system.
This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.